A recent study indicates that Medicaid expansion under the ACA has led to significant improvements in long-term survival rates for cancer patients, emphasizing the enduring benefits of enhanced health care access.
A new study published in the journal Cancer Discovery has found that that Medicaid expansion in U.S. states was associated with improved five-year overall and cause-specific survival rates among cancer patients.
Background
A key provision under the Patient Protection and Affordable Care Act (ACA) implemented in 2014 allowed states to expand Medicaid eligibility for adults with incomes up to 138% of the federal poverty guidelines.
Prior studies have suggested that Medicaid expansion leads to increased insurance coverage, greater access to cancer screening, and improved two-year survival rates.
However, its impact on longer-term survival for cancer patients was unclear until now.
“Studying the impact of Medicaid expansion on longer-term survival outcomes among individuals diagnosed with cancer is important for guiding evidence-based decision-making by policymakers and advocates for maintaining and expanding Medicaid,” lead author Elizabeth Schafer, an associate scientist at the American Cancer Society, said in a news release.
Study Methodology
To address this gap, the researchers employed a difference-in-differences (DD) study design.
This approach compared pre-expansion data from 2007-2008 with post-expansion data from 2014-2015, effectively using states that did not adopt Medicaid expansion as a control group.
Utilizing the Cancer in North America Survival dataset, the researchers analyzed data from 1,423,983 cancer cases diagnosed in adults aged 18 to 59 years.
They compared five-year survival rates from states that expanded Medicaid with those that did not. The analysis included 26 states with Medicaid expansion and 12 without.
Results
The findings were compelling.
Adjusted for various covariates, the study found significant improvements in survival rates among cancer patients in Medicaid expansion states:
- Rural areas: Improvements of 2.55 percentage points in cause-specific survival and 3.03 percentage points in overall survival.
- High-poverty areas: Improvements of 1.54 percentage points in cause-specific survival and 1.69 percentage points in overall survival.
- High-mortality cancers: Marked improvements in both cause-specific and overall survival.
- Non-Hispanic Black individuals: A notable increase in overall survival with a 1.05 percentage point improvement.
- Non-Hispanic Whites: Increases of 0.37 percentage points in cause-specific survival and 0.57 percentage points in overall survival.
For all cancer patients in expansion states, adjusted cause-specific survival improvements were observed. However, these improvements were not always statistically significant.
“The evidence supporting Medicaid expansion in improving outcomes for individuals diagnosed with cancer is clear,” Schafer added.
Currently, 10 states — Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming — have yet to expand Medicaid.
“Research has shown that Medicaid expansion can increase cancer screening prevalence, early-stage diagnosis, short-term survival, and now — according to our own analysis — five-year survival. These findings underscore the importance of expanding Medicaid in the 10 remaining nonexpansion states and protecting expansion in the states that have already implemented it in order to improve outcomes for all individuals,” Schafer concluded.
Study Limitations
The study acknowledged potential confounding factors such as the ACA’s overall impact on insurance coverage, which may skew the data.
Additionally, the dataset did not include individuals with missing cause-of-death or sociodemographic information.